The Secret Illness. Part One: Understanding Obsessive Compulsive Disorder. Part Two: Managing Obsessive Compulsive Behavior in Schools

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CLARE MULLEN, PRODUCER The Secret Illness. Part One. Understanding Obsessive Compulsive Disorder. Part Two: Managing Obsessive Compulsive Behavior in Schools. Edmonton, ON: Dymphna Productions, 2000, two video tapes, 33 minutes each. (C$195 each or $345 the set; Fax: (780)432-7309) Reviewed by AIDAN STOKES

Producer Clare Mullen undertook the production of the two-video set, "The Secret Illness," with a group of clinicians, educators, and parents of children with Obsessive Compulsive Disorder (OCD) in an effort to help families and teachers understand and cope with the disorder. Part I, entitled "Understanding Obsessive Compulsive Disorder in Children," deals with the impact of the disorder on children and their families, while Part II, "Managing Obsessive Compulsive Behaviour in Schools," offers education about the disorder and outlines behavioural management strategies for school personnel.

An educational videotape should inform but not overstate the difficulties with the disorder. Thus, the content of such videotape may seem bland in comparison to the depiction of the disorder in commercial TV productions, many of which serve to appal rather than inform through sensationalization of the subject in the interests of "good television." Invariably, it seems that it is the most severe cases with the most bizarre symptoms that are portrayed. One of the main challenges for the producer of an educational videotape is to present material that is relevant to the majority of individuals with the disorder and their families, and to do so in an accurate, sympathetic, and hopeful manner. Information needs to be presented with a perspective sufficiently broad to allow most with the disorder to identify with some of the individuals portrayed. The approach should be balanced and realistic and reflect current knowledge of the disorder.

In applying the above criteria to "The Secret Illness," how well does this venture succeed? With rather mixed success, in my view: Certain segments are excellent, while others are somewhat pedestrian. Part I commences with an overview of OCD provided by a psychologist and a psychiatrist. The information presented is generally accurate, but certain key findings in the literature have been either minimized or omitted. In contrast to the data presented, it is now generally accepted that approximately 2% of children and adolescents are estimated to be affected by OCD (Zohar, 1999). Further, there is scant reference made to subcategories and co-morbidities, and given that these are often important in treatment planning, their omission is notable. There was also little mention of the familial or genetic contributions to the disorder.

The next segment of the video shows clips of interviews with children as they discuss their symptoms and the impact upon them. These are handled sensitively with a couple of poignant reminders of the severity of the impact of this disorder on quite young children. However, one segment with a young man whose face was hidden, presumably in the interests of confidentiality, was upsetting to one parent whom I asked to review the video. She commented "[it was as] if he had committed a crime." The next segment where parents discussed how they coped with having OCD in the family is perhaps the most disappointing due to the heavy emphasis on the difficulties encountered, with little discussion of the strategies which the parents might use in dealing with a child with the disorder.

The section on treatment covered the empirically supported treatments but not in sufficient detail. Drug treatment is suggested as the primary mode of intervention in the disorder. Certainly, pharmacological intervention plays a major role in the treatment of childhood OCD and is often effective, but little attention was paid to its pitfalls, including nonresponse and partial response as well as some of the adverse effects of drug treatment. …